颅内感染者脑脊液细胞学检查的临床意义

CLINICAL SIGNIFICANCE OF CSF CYTOLOGICAL EXAMINATION FOR INTRACRANIAL INFECTION

目的探讨CSF细胞学检查对颅内感染性疾病的诊断价值。方法先行CSF细胞计数等常规检查,然后应用粟氏FMU-5型CSF细胞玻片沉淀器收集细胞,涂片自然干燥后,行瑞-姬复合染色,用油镜进行细胞学分类检查。根据涂片中细胞出现的种类及多少得出细胞学反应类型。结果 308例患者CSF细胞学检查具有诊断价值为249例(80.8%),无诊断价值者59例(19.2%)。病脑主要出现淋巴细胞反应,其次为转化型淋巴细胞反应;化脑主要以中性粒细胞反应为主,其次为混合细胞反应;结脑主要呈现转化型淋巴细胞反应,也有较多的混合细胞反应及淋巴细胞反应。在病脑、化脑、结脑3种颅内感染患者中CSF细胞学检查有价值的诊断以化脑最高,其次为结脑、病脑,阳性诊断率分别为84.0%、82.4%、76.2%。结论 CSF细胞学检查对颅内感染性疾病的诊断、病期判断和免疫反应机制阐述具有一定价值。

Objective To explore the diagnostic value of cytological examination of cerebrospinal fluid （CSF） for patients with intracranial infection. Methods CSF cells were counted at first. Then, the cells were collected with CSF cell slide precipitator of Su FMU-5 type. The smear received natural drying, Wright-Gimsa staining and were categorized by oil immersion. Cytological types were judged according to the types and the number of cells on smears. Results In the 308 cases, diagnostic value was found in 249 cases （80.8%） and no diagnostic value was found in 59 cases （19.2%）. In the cases of viral meningitis, the lymphocyte reactions were the main reactions and the transformed lymphocyte reactions were the sec- ond. In the cases of purulent meningitis, neutrophil responses were the main reactions and the mixed cell reactions were the second. In the cases of tuberculous meningitis, the transformed lymphocyte reactions were the main reactions and the mixed cell responses and lymphocyte reactions were also commonly found. The diagnostic rates of purulent meningitis was the highest among the three kinds ofmeningitis by CSF cy- tological examination, followed by tuberculous meningitis and viral meningitis, with the rate of positive di- agnosis were 84.0%, 82.4%, 6. 2% respectively. Conclusion CSF cytological examination is valuable in diagnosing intracranial infection, staging judgment and immune reaction mechanism ~[ahorntlnn